Any Iowa hospital or clinic seeking Medicaid payment for providing abortions will need the approval of the state’s most prominent abortion opponent: Gov. Kim Reynolds.
No one bothers to try.
Iowa’s Medicaid regulations include an unusual policy that requires the governor’s office to sign off before the public health insurance program can pay for any abortion services, even if they meet the state’s strict criteria.
Reynolds is a Republican and a staunch opponent of abortion. In more than six years as governor, he has never been asked to approve Medicaid payments for abortions, said his spokesman, Kollin Crompton.
The novel policy, enacted a decade ago by lawmakers, leaves abortion providers with a choice: Swallow the cost of the procedure, or risk a fight with the governor.
The state’s Medicaid program spends about $8 billion a year to pay about 800,000 Iowans who are low-income or have disabilities. It allows for payment of abortions if the pregnancy endangers the woman’s life, is the result of rape or incest, or involves a malformation of the fetus. The Iowa Department of Health and Human Services sends out a form for abortion providers to fill out for Medicaid reimbursement, but the program hasn’t paid for any abortions in several years, said spokesman Alex Carfrae.
The federal government, which pays more than half of Medicaid costs, helps pay for abortions only in cases of rape or incest or when the pregnancy endangers the woman’s life. But it requires state Medicaid programs to cover such cases.
Most federal Medicaid programs pay for at least a few abortions, according to a 2019 report from the Government Accountability Office. The report found that in fiscal years 2013 through 2017, only Iowa, South Dakota, and Wyoming reported no abortions that met federal criteria.
Abortion is still legal within the first 20 weeks of pregnancy in Iowa, where 4,062 abortions were reported in 2022. Reynolds signed a bill in July that would have banned most abortions after six weeks, and is fighting in court to enforce the law. However, the ban on abortion will allow exceptions in cases of rape, incest, fatal fetal diseases, and medical emergencies.
Iowa’s Medicaid program paid for 22 abortions in the fiscal year before lawmakers passed the governor’s oversight law in 2013. Most are performed at the University of Iowa Hospitals and Clinics in Iowa City, a public facility that handles many of the most complicated pregnancies in Iowa. . After the law went into effect, hospital leaders decided to pay for abortions out of facility funds instead of trying to bill Medicaid.
Jean Robillard, then vice president of the University of Iowa Hospitals, declined at the time to explain how the federal law affected the decision to end Medicaid billing for abortions. “I don’t want to get political in this,” he told the Des Moines Register.
University of Iowa Hospitals spokeswoman Laura Shoemaker said the hospital has never billed Medicaid for abortions in years past. He declined to comment further.
UnityPoint Health, a large nonprofit hospital system based in West Des Moines, also occasionally billed Iowa Medicaid for eligible abortions before the governor’s authorization law went into effect. UnityPoint declined to comment on its current practice.
When the law was implemented, it was called an exception by the Guttmacher Institute, a national nonprofit that supports abortion rights. The group still lists Iowa as the only state that requires the governor’s approval for Medicaid payments for abortions. But the spokesman said the agency could not say for sure that no other state had implemented the law.
The policy went into effect when Reynolds’ predecessor, Republican Terry Branstad, was in office. Branstad also opposed abortion but proposed repealing the law. A spokesman for Reynolds declined to say whether the current governor approves of the law.
Maggie DeWitte, executive director of Pulse Life Advocates, an Iowa-based group that opposes abortion, said she favors the policy as a way to limit the use of taxpayer dollars for the procedure.
“I don’t think it’s something that the government should be paying for.” Killing an innocent person,” he said. “We have to have as many stops as possible.”
Sally Frank, a law professor at Drake University in Des Moines who studies women’s rights issues, said the law appears to be aimed at preventing Medicaid claims. “It’s kind of setting it up for failure,” he said.
Frank, who supports abortion rights, said a hospital or clinic would have strong legal grounds to challenge any denial of the governor’s Medicaid for an abortion that meets Iowa’s criteria.
He noted that states are required to cover Medicaid services defined under federal law. He added that if the governor withholds payment without giving a valid reason, the provider can appeal in court saying they were denied due process. “It should not be at the governor’s discretion.”
But he wasn’t surprised to hear that no hospitals or clinics challenged the policy, given the state’s increasingly conservative politics.